title: Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up.
abstract: BACKGROUND
  Endoscopic papillectomy is increasingly used as an alternative to surgery for ampullary adenomas and other noninvasive ampullary lesions.
  
  
  OBJECTIVE
  To measure short-term safety and efficacy of endoscopic papillectomy, define patient and lesion characteristics associated with incomplete endoscopic resection, and measure adenoma recurrence rates during long-term follow-up.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary-care academic medical center.
  
  
  METHODS
  All patients who underwent endoscopic papillectomy for ampullary lesions between July 1995 and June 2012.
  
  
  METHODS
  Endoscopic papillectomy.
  
  
  METHODS
  Patient and lesion characteristics associated with incomplete endoscopic resection and ampullary adenoma-free survival analysis.
  
  
  RESULTS
  We identified 182 patients who underwent endoscopic papillectomy, 134 (73.6%) having complete resection. Short-term adverse events occurred in 34 (18.7%). Risk factors for incomplete resection were jaundice at presentation (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.07-0.69; P = .009), occult adenocarcinoma (OR 0.06; 95% CI, 0.01-0.36; P = .002), and intraductal involvement (OR 0.29; 95% CI, 0.11-0.75; P = .011). The en bloc resection technique was strongly associated with a higher rate of complete resection (OR 4.05; 95% CI, 1.71-9.59; P = .001). Among patients with ampullary adenoma who had complete resection (n = 107), 16 patients (15%) developed recurrence up to 65 months after resection.
  
  
  CONCLUSIONS
  Retrospective analysis.
  
  
  CONCLUSIONS
  Jaundice at presentation, occult adenocarcinoma in the resected specimen, and intraductal involvement are associated with a lower rate of complete resection, whereas en bloc papillectomy increases the odds of complete endoscopic resection. Despite complete resection, recurrence was observed up to 5 years after papillectomy, confirming the need for long-term surveillance.
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA; Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: Wiriyaporn
authors.initials: W
authors.lastname: Ridtitid
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Damien
authors.initials: D
authors.lastname: Tan
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Suzette E
authors.initials: SE
authors.lastname: Schmidt
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Watkins
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Coté
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology
keywords: FAP; PEP; familial adenomatous polyposis; post-ERCP pancreatitis